Communities of Color and Participation in Breast Cancer Research
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40 percent of Americans belong to a minority racial or ethnic group, yet only 2 percent of cancer clinical trials have studied enough minorities to provide useful information to these populations. In this webinar Dr. Susan Love, from the Dr. Susan Love Research Foundation, presents on the importance of including communities of color in breast cancer research, the barriers to diversifying research, and what can be done to address them.
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Communities of Color and Participation in Breast Cancer Research
- 1. BREAST CANCER IN WOMEN OF COLOR: IT’S COMPLICATED DR. SUSAN LOVE RESEARCH FOUNDATION Susan M Love, MD, MBA Chief Visionary Officer, Dr. Susan Love Research Foundation
- 2. DR. SUSAN LOVE RESEARCH FOUNDATION
- 3. OLAPADE 2015 WOMEN OF COLOR: THE PERFECT STORM Differences in tumor biology and genomics plus Differences in patterns of care equals Breast cancer mortality gap
- 4. INCIDENCE AND DEATH RATESBREAST CANCER IN AFRICAN AMERICANS IS MORE DEADLY BUT NOT IN HISPANIC WOMEN OR ASIAN/PACIFIC ISLANDERS Death rates, however, are higher Incidence rates in AA women are similar to other races and ethnicities
- 5. ALTHOUGH THERE IS SOME IMPROVEMENT IN MORTALITY, THERE ARE STILL LAGS OVER OTHER ETHNIC GROUPS
- 6. MORTALITY TRENDS BY RACE SEER 1968-2008
- 7. WHY?
- 8. THE DEATH RATE IS HIGHER? African American women are more likely to die of breast cancer than Caucasian women at every age • Why • Less access to screening mammography • Less access to state of the art care • Biology • Lifestyle • ??? Newman JAMA Oncology 2017
- 9. WHY IS THE DEATH RATE HIGHER? Its complicated!
- 10. SYSTEMIC AND LOCAL IT’S THE NEIGHBORHOOD
- 11. SCREENING AND EARLY DETECTION ACCESS TO CARE?
- 12. LOS ANGELES COUNTY PER CENT BREAST CANCER CASES DIAGNOSED AT EARLY STAGE LATE DETECTION OR ACCESS TO CARE non Hispanic whites 3,398 (72.6%) African American 857 (64.9%) Hispanic 2,069 (65.3%) Asian/Pacific Islander 1,300 (69%) Race all races 80% NH whites 80% NH Blacks 87% age 45-65 79% age over 65 82% no med care 47% no insurance 50% ACCESS TO CARE
- 13. BRCA 1/2 IS IT BE HEREDITARY ? Northern California Breast Cancer Family Registry showed BRCA 1 mutation is 16.7% in African American Cases diagnosed under 35 and 7.2% in non Hispanic Jewish whites • But in a study by Armstrong et al , AA women with a family history of breast or ovarian cancer were (1/5 as often) significantly less likely than white women to receive testing or counseling regarding BRCA1/2 testing Hispanic women of Mexican descent have been found to carry hereditary mutations • 35 mutations were identified in 3.4% including BRCA 1 and 2. Only 5/34 had a family history
- 14. Term Latina or Hispanic Can Cover Several Ethnic/Racial Groups LATINA GENETICS ARE COMPLICATED
- 15. COULD THERE BE AN AFRICAN MUTATION? TRIPLE NEGATIVE BREAST CANCER IS MORE OFTEN GENETIC Ghana African American
- 16. GEOGRAPHICALLY DEFINED ANCESTRY INFLUENCES THE RISK OF TNBC (NEWMAN 2017)
- 17. • Mammography process is broken with quality differences in the manner in which centers provided care and reported results Ansel et al 2009 • Delays in treatment 29.2 days AA vs 22.5 days for NHW • African American women not receiving guideline concordant treatment (19%-11%) • Under treated • Not enrolled in clinical trials • Comorbidity such as obesity QUALITY OF CARE
- 18. SOLUTIONS QUALITY OF CARE • Insurance • Patient education and physician communication • Patient navigation • System change • “Interventions aimed at health care system improvement are few, with the responsibility for change resting with the patient rather than the care delivery system. “ • “The majority of interventions failed to involve major stakeholders, including providers, health care institutions, its organizers and policy makers and accordingly were unlikely to succeed in creating meaningful change. “ “successful strategies for reducing health disparities, are culturally tailored to meet patient’s needs, employ multidisciplinary teams of care providers and target multiple leverage points along a patients’s pathway of care. “Chin et al
- 19. ARE THERE OTHER FACTORS? • • • • Biology • Subtype • Age • Hereditary • Lifestyle • Lactation • Obesity • Stress ARE THERE OTHER FACTORS?
- 20. SUBTYPES OF BREAST CANCER BIOLOGY: SUBTYPE There are four molecular markers that we use to differentiate the biology of breast cancer into three groups: Luminal A and B (hormone positive): estrogen receptor +, progesterone receptor + HER 2 positive: epidermal growth factor over expressing Triple negative (basal): estrogen receptor -, progesterone receptor -, HER2 -
- 21. SUBTYPES AND AGES AFRICAN AMERICAN WOMEN IN CALIFORNIA
- 22. GENETIC? Triple negative (basal) breast cancer • more likely to be hereditary (BRCA1) • more common in AA women • Less BRCA 1 in AA women
- 24. ARE THERE OTHER FACTORS? • • • • Biology • Subtype • Age • Hereditary • Lifestyle • Obesity • Stress • Lactation ARE THERE OTHER FACTORS?
- 25. ARE THERE FACTORS THAT INCREASE OR DECREASE BREAST CANCER RISK LIFESTYLE It’s the neighborhood…. • Stress/Inflammation • Breastfeeding • Obesity
- 27. INVOLUTING BREAST MORE CANCEROGENIC • Women who breast feed have less breast cancer • AA women less likely to breast feed • Involution biology is tumorigenic • NSAIDS can reduce risk
- 28. MUZIK 2016 ENHANCING BREASTFEEDING AMONG AFRICAN AMERICAN WOMEN
- 30. IT'S COMPLICATED
- 33. MORE RESEARCH HOW WILL WE SORT THIS OUT? We need to study all women and men with breast cancer! We need to study ALL stages of breast cancer from in situ to metastatic disease! We need to move from mice to people! The only way to have the research represent ALL of us, is to have everybody participate! Sign up at ArmyofWomen.org
- 34. THE ARMY OF WOMEN NEEDS YOU! TO HELP US REPRESENT ALL WOMEN
- 35. SIGN UP AT WWW.ARMYOFWOMEN.ORG HOW THE ARMY OF WOMEN WORKS Eblasts: Be the first to hear about studies recruiting with the Army of Women Current Studies: Learn about all Army of Women supported research studies Webinars: Listen to researchers discuss their studies and results Your Impact: See how your support has changed the face of breast cancer research
- 36. HELP ANSWER THE QUESTIONS BY PARTICIPATING IN RESEARCH YOURSELF! COMMIT TO LOVE!